NPIMap

Organization Active NPI

Family Eye Care Center & Optical Gallery Inc.

  • Ophthalmology Physician
  • Westford, MA
National Provider Identifier
1003900382
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
FAMILY EYE CARE CENTER & OPTICAL GALLERY INC.
Practice address
5 Cornerstone Square
Suite 101
Westford, MA 01886-3198
Phone
(978) 692-1400
Fax
(978) 692-5995
NPI assigned
Oct 3, 2006
Last updated
Oct 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dwayne B Baharozian, M.D.NPI 1669477477
Title
President
Phone
(978) 692-1400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

5 Cornerstone Square
Suite 101
Westford, MA 01886-3198

Mailing address

5 Cornerstone Square
Suite 101
Westford, MA 01886-3198
Phone (978) 692-1400

Other identifiers 5

IdentifierTypeStateIssuer
23648OtherMAFALLON
740025OtherMATUFTS
M16086OtherMABC/BS
9775137MedicaidMA
150559OtherMAHARVARD PILGRIM HEALTH CA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050419000907 MA Part B Supplier - Clinic/Group Practice 0547208761 Receives reassigned benefits from 11 practitioners
Practice locations: Westford, MA

National Provider Directory

National Provider Directory
Tax ID family
Family Eye Care Center Opt2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

133 Littleton Rd
Ste 201
Westford, MA 01886
Phone (978) 399-0017

5 Cornerstone Sq
Ste 101
Westford, MA 01886
Phone (978) 692-1400

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1003900382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 CORNERSTONE SQUARE",
            "address_2": "SUITE 101",
            "city": "WESTFORD",
            "state": "MA",
            "postal_code": "018863198",
            "telephone_number": "978-692-1400",
            "fax_number": "978-692-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CORNERSTONE SQUARE",
            "address_2": "SUITE 101",
            "city": "WESTFORD",
            "state": "MA",
            "postal_code": "018863198",
            "telephone_number": "978-692-1400",
            "fax_number": "978-692-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY EYE CARE CENTER & OPTICAL GALLERY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "BAHAROZIAN",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-692-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "23648",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "740025",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "M16086",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9775137",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH CA",
            "identifier": "150559",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.